What Is Academic Detailing for Medical Treatments?

Marketing Facts about Medical Treatments, Pharmaceuticals and Medical Devices

Updated November 2015

Academic detailing is a way to improve health care by combining the interactive, one-on-one communication used by medical salespeople with the evidence-based, noncommercial information generated by medical experts.

Academic Detailing involves trained health care professionals visiting with practicing physicians in their offices and presenting the most up-to-date clinical information available. It is a quality-oriented approach that helps physicians make appropriate clinical decisions, ideally based on the best available safety, efficacy, and cost-effectiveness data. Through the dialogue it creates, academic detailing has the potential to improve patient care and health outcomes while helping to control costs, thus aligning the interests of patients, physicians and payers.

Why Academic Detailing?

Doctors with access to unbiased evidence-based information regarding treatment options deliver better care and can help to control costs. Academic detailing is a proven way to provide this information in an effective and impactful way. Health care budgets are under increasing strain. Reducing inefficient and ineffective use of drugs and therapies can help reduce that strain, while improving quality of care. 

Broad Applicability to Health Care Challenges

Academic Detailing can be used to address multiple areas within healthcare, such as:

  • improving clinician knowledge of new clinical guidelines or health threats
  • selecting  treatments to increase effectiveness and safety or to decrease overuse
  • improving patient education by helping clinicians communicate vital information to patients
  • increasing diagnosis or screening for overlooked conditions
  • increasing utilization of complimentary resources such as community-based public health programs

History of Academic Detailing

Academic Detailing was developed in the 1980s in studies done by Dr. Jerry Avorn. These studies developed the first non-commercial “un-ads” for physicians, presenting evidence on best practices in a concise and graphically engaging format. The un-ads contained clinical background information, specific evidence-based prescribing recommendations, and were supported by patient educational materials. This approach was popular with physicians and effective in improving physicians prescribing habits.[1]

Since then, countries around the world including Australia, Canada, the Netherlands, and the United Kingdom have created nationwide academic detailing programs. Academic detailing programs exist in many states in the US. New Programs continue to be established.  Academic detailing has been studied extensively over the last twenty five-plus years, and a recent large systematic review of 69 studies confirmed the ability of Academic Detailing to improve medical practice.[2]

Mechanisms used for Establishing Academic Detailing Programs.

City, State and Federal governments have used a variety of mechanisms to establish academic detailing programs in the United States. They have used these programs to address a wide range of health concerns including: diabetes, osteoporosis, depression, HIV Testing, childhood obesity, smoking cessation, and hypertension.

Programs have been established as part of legislative initiatives in Maine, Massachusetts and New York. Other programs have been established within executive branch initiatives such as in Pennsylvania and South Carolina. Some academic detailing programs have been established or supported via grants, either from agencies within the federal government, or foundations.

Funding of programs, which typically can range from $100,000 to over $1,000,000 per year has come from a wide variety of sources including: lottery proceeds, general funds, fees, Medicaid matching funds, settlement money and other sources.

The Veterans Affairs (VA) health care system has begun several academic detailing programs to help VA psychiatrists do a better job of caring for veterans with mental health problems, and is developing extensive documentation of their impact, labeled "highly effective" by Dr. Mike Fisher of RaCAD.

In the private sector one of the oldest, long-lived academic detailing initiative is used by the Kaiser health system.

Sample State Programs

 

State/
District

Year 
Established

Statute / Means of Establishment

District of Columbia

2007

2007 District of Columbia Legislative Bill No. 364
Independent Drug Information Service (iDiS) programs  are partly funded by the Washington DC, Department of Health

Idaho

 2009

None (pilot program)

Louisiana  2012

None. The Louisiana Comprehensive  Cancer Control Program participate in the May 2012 NaRCAD training session.

Massachusetts

 2009

Chapter 305, Acts of 2008

Maine

 2009

Established by statute - 2009 ME H.P. 881

New York

 2008

Basesd on state statute, 2007-08.  New York State Medicaid Prescriber Education Program (NYSMPEP) is a partnership between the New York State Department of Health which provides funding and the State University of New York (SUNY). 

North Carolina  2015 North Carolina's AHEC Program (Ann Lefebvre)

Pennsylvania

 2005

State executive agency initiative sponsored by the PACE Program of the Pennsylvania Department of Aging. It funds academic detailing for about $1 million per year, compared to PACE prescription benefits of $724 million in 2007. It fields ten independent drug consultants in the 28 most populous counties. Four drug classes with contemporary concerns are chosen per year as topics, including non-steroidal anti-inflammatory drugs, cox-2 inhibitors, gastrointestinal medications, anti-platelet therapy, lipid lowering drugs, antihypertensives, type 2 diabetes management and antidepressants. To date, nearly 4,000 encounters have been completed with over 1,000 unique physicians.  PACE: https://pacecares.fhsc.com/

All PACE / iDiS clinical materials are available for non-commercial use online at www.RxFacts.org.  PACE is authorized by statute; academic detailing did not require separate authority.

South Carolina  

SC Medicaid Academic Detailing Program, SCORxE which stands for "South Carolina Offering Prescribing Excellence."  The program  is a collaborative effort between the South Carolina Department of Health and Human Services (SCDHHS) and the SC College of Pharmacy (SCCP).  SCDHSS provided $1.98 million to the College to provide academic detailing services to physicians who serve Medicaid patients with mental health disorders, HIV/AIDs or cancer. 
Online details at www.sccp.sc.edu/centers/SCORxE/index.aspx

Vermont

 1999

Originally started by Blue Cross; later established in statute, 2000 VT Act 80


Academic Detailing and Health Reform

Academic detailing has an established record of improving the use and effectiveness of health care resources. As increased energy and focus is provided to improvements in our health care system, academic detailing can be an important tool for states to employ.

Examples of Materials Currently in Use by Individual States

These reports were published for use in partucular settings.  They are listed for information only. NCSL is not responsible for links to third party websites.

The National Resource Center for Academic Detailing (NaRCAD)

The National Resource Center for Academic Detailing (NaRCAD) was created to help establish and support academic detailing programs in improving the quality of care. NaRCAD is supported by a grant from the Agency for Healthcare Research and Quality (AHRQ).  NaRCAD provides training, expertise, and materials which can be leveraged by Academic Detailing programs across the country to more effectively and economically achieve their goals.

NaRCAD has extensive experience in the United States at designing and implementing all aspects of an academic detailing program.  The Co-Director of NaRCAD, Dr. Jerry Avorn, pioneered the field of Academic Detailing.  Its team members have worked to implement and provide assistance to numerous academic detailing programs across the country.  More information on NaRCAD can be found at www.NaRCAD.org.
> Academic Detailing Tools, Guides, & Presentations - updated 2015

An Interview with Dave Lehmann, M.D., Pharm.D. -Medical Director, New York State Medicaid Prescriber Education Program.  Spring 2012
(Excerpt)  Q:    Can you provide us with some background on the NYSMPEP academic detailing program?
The New York State Medicaid Prescriber Education Program (NYSMPEP) is a partnership between the New York State Department of Health and the State University of New York.  NYSMPEP was formed in April 2008 in response to legislation to provide prescribers with an evidence-based non-commercial source of pharmacotherapy information.  The information is presented to prescribers via specially trained pharmacists and doctors known as educators.  There are approximately ten full and part-time educators deployed across New York State.  The program is funded by the New York State Department of Health.
Q:   Are there areas in which the program has had an especially positive impact on patient care?
Yes, appropriate Palivizumab use in RSV (respiratory syncytial virus).  We performed direct AD outreach to high volume users either using one-on-one to one-on-small-group interventions.  Currently, we are collaborating with the Division of Pharmacoepidemiology at Brigham and Women’s and SUNY Upstate on a manuscript of the economic impact of this intervention done by that will show how large the impact was. 


Footnotes
[1] Avorn JA and Soumerai SB. Improving Drug-Therapy Decisions through Educational Outreach — A Randomized Controlled Trial of Academically Based Detailing.  New England Journal of Medicine. 1983; 308:1457-1463.

[2] O’Brien, MA et al. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews, 2007; Issue 4. Art. No.: CD000409.

NCSL Prescription Drug Resources

Prescription Drugs Overview, Generics, Brands & Purchasing Agreements - Two NCSL Health Cost Containment & Efficiencies Briefs; resources updated January 2016.
 

Other Opinions and Resources

What’s New at NaRCAD: 2016 At-A-Glance -1/16/2016

Patient-Centered Outcomes Research Institute (PCORI): Jean Slutsky, Chief Engagement and Dissemination Officer, reviewed the key principles for effectively communicating research results that improve patient health outcomes.- 11/1/2014